None listed
Conditions
Brief summary
PULSAR stands for ‘Principles Unite Local Services Assisting Recovery’. The overall aim of the PULSAR project is to imbed recovery-oriented practice in primary care and specialist mental health services in the Monash Health catchment. Recovery-oriented practice involves supporting a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential. A training package has been developed in the UK that promotes recovery-oriented practice in teams. We will adapt these materials to needs of the Australian and Victorian mental health care system, the local cultural and legal contexts. The PULSAR intervention involves training staff in recovery-oriented practice using these adapted materials. The current trial pertains to the evaluation of the PULSAR intervention within primary mental health care services; the evaluation of PULSAR in specialist care services is being evaluated in a separately registered trial with ANZCTR. In the primary care trial, we planned to deliver the PULSAR intervention to staff at up to 30 primary care sites (clusters) across the Monash Health catchment area and adjoining Medicare Local regions and evaluate the effect on adult mental health patients of these services. Half of the clusters would be randomised to receive the PULSAR intervention in year one, the other half in year two. Clusters will be separated into similar types of services before randomisation to ensure cluster types are balanced across treatment conditions. Our key hypotheses are that consumers in the PULSAR intervention clusters will experience significantly greater gains in personal recovery, health and wellbeing compared to consumers receiving care in control groups. Data will be collected cross-sectionally from a minimum of 126 consumers at baseline, 9 and 18 months. The total number of participants will be a minimum of 378 consumers. Consumers will be recruited into the study if they respond to an invitation letter by returning a signed consent form and the project questionnaires mailed by their current service on behalf of the researchers. The questionnaires can also be completed online. The above documents the study design as intended to be carried out. However, we did not achieve the intended recruitment targets therefore we adapted the analysis to a pre-post design. This adaptation and final analyses that flow from that are described in the final results paper (see "Study Results"). The significance of the work will be to develop, evaluate, and make readily available a set of training materials and organisational change tools that would facilitate participating mental health services working together to successfully delivery recovery-oriented practice. Embedded qualitative studies explored GP and patient perspectives of recovery-oriented practice and investigated the relevance of the QPR within culturally and linguistically diverse communities.
Interventions
The PULSAR intervention is a training intervention that will be delivered by the research team to participating general practitioners in primary care. The intervention focuses on teaching and promoting recovery-oriented practice to staff. PULSAR stands for "Principles Unite Local Services Assisting Recovery". Recovery-oriented practice involves supporting a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full pot
The PULSAR intervention is a training intervention that will be delivered by the research team to participating general practitioners in primary care. The intervention focuses on teaching and promoting recovery-oriented practice to staff. PULSAR stands for "Principles Unite Local Services Assisting Recovery". Recovery-oriented practice involves supporting a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential. A package of interventions, developed and trialled by the Refocus Team, Institute of Psychiatry, King's College London UK, promotes recovery-oriented practice in mental health teams. In the PULSAR project, we will adapt these materials for the Australian primary care sector including privately-owned GP practices and government-funded Community Health Services. The content and process of training will be sensitive to the needs of the Victorian mental health and primary care systems and the local cultural and legal contexts. PULSAR training involves attendance at a 4.5 hour interactive workshop. The training has been reviewed and accredited as a Category 1 activity by the Royal Australian College of General Practitioners and the Australian College of Rural and Remote Medicine. It is also recognised by General Practice Mental Health Standards Collaboration towards Mental Health Skills Training. The training will be delivered by mental health clinicians, including experienced trainers from the study team with co-delivery by consumer trainers for at least half the time and carer involvement for at least one hour of training. Also to be offered are optional monthly one hour follow up sessions. The training and follow up sessions will aim to train and support GPs to adopt recovery-oriented practices. A schedule of training will be provided to trainers along with standardised training packs including use of videos to provide standardised content. Trainers will be asked to keep a record of training and to record any deviations from the schedule and use of materials. We will deliver these interventions and evaluate the process in a stepped-wedge cluster study design, together with an embedded qualitative study to identify the contextual enablers and challenges to implementing recovery-oriented practice. Half the primary care sites (clusters) will be randomised to receive the PULSAR intervention in year 1 and the other half in year 2. Data collection consists of cross-sectional surveys collected from patients of study GPs at baseline and again at the end of 9 months and 18 months, and semi-structured qualitative interviews with GPs and patients at 3 and 9 months following the GP training. To account for potential contamination of the intervention 'dosage' to be received within each cluster (i.e., the GP who had the PULSAR training), a dosage variable will be included in the modelling. This variable will be based on staff movements, which will be collected every three months. Specifically, the site GP(s) will be contacted every three months and it will be recorded if a site GP leaves the service, thereby decreasing the ‘dosage’ at the centre.
Sponsors
Monash University
Study design
Allocation
Randomised controlled trial
Intervention model
Other
Primary purpose
Educational / counselling / training
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
18 Years to 74 Years
Healthy volunteers
No
Inclusion criteria
CONSUMERS 1. Aged 18 years or over 2. Aged less than 75 years 3. Have English proficiency 4. Are able to provide informed consent 5. Are patients of the participating general practitioners (GPs) i.e., consulting with the participating GP in at least 50% of their visits to the clinic or is identified by the GP as a patient. In addition: 6. Seven of the 10 patients recruited per cluster, in the previous 3-months prior to data collection, must have either 6.1 a mental health plan made or reviewed and/or 6.2 received any class of antidepressant medication on a continuing basis (prescribed for a least a month) to provide treatment for a mental illness. If insufficient numbers are identified the time frame will be moved out to 6 months. 7. Three of the 10 patients recruited from each cluster must have 7.1 a clinical diagnosis of psychosis, e.g. schizophrenia, schizoaffective disorder, bipolar disorder and/or 7.2 been prescribed antipsychotic medication in the previous 6 months. STAFF 1. Work within a community health service or accredited primary care site located in the catchment of Monash Health. Depending on response to initial recruitment, this may be extended to any GP practice that is within Medicare Local regions that overlap with the Monash Health catchment. 2. Have worked at this practice for a least 12 months. 3. The participating site is the principal site of their clinical practice and the majority of their services are devoted to generalist primary care. 4. Commit to participating in PULSAR training. 5. Commit to identifying eligible patients and sending study invitation letters and study surveys to potential patient participants for the study.
Exclusion criteria
People who are in prison
Outcome results
None listed